Summary Skull base surgery for malignant tumors of the nasal cavity and paranasal sinuses

OBJECTIVEThe anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity.METHODSFive formalin-injected cadaveric specimens were used for this study (10 approaches). A classic pterional approach was performed. An OPC was created through the inferior orbital fissure, between the orbit and the PPF, by transposing the PPF inferiorly. The extent of the OPC was measured using neuronavigation and manual measurements. Two illustrative cases using the OPC to access skull base tumors are presented in the body of the article.RESULTSVia the OPC, the SphS, MaxS, ethmoid sinus (EthS), and nasal cavity could be accessed. The use of endoscopic assistance through the OPC achieved better visualization of the EthS, SphS, MaxS, clivus, and nasal cavity. A significant gain in the area of exposure could be achieved using the OPC compared to the AMT (22.4 mm2 vs 504.1 mm2).CONCLUSIONSOpening of the AMT and transposition of V2 and the contents of the PPF creates the OPC, a potentially useful deep keyhole to access the paranasal sinuses and clival region through a middle fossa approach. It is a valuable alternative approach to reach deep-seated skull base lesions infiltrating the cavernous sinus and middle cranial fossa and extending into the paranasal sinus.

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Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity

American Journal of Rhinology and Allergy ◽

10.1177/1945892420908749 ◽

2020 ◽

Vol 34 (4) ◽

pp. 487-493 ◽

Cited By ~ 1

Author(s):

Erin K. Reilly ◽

Colin T. Huntley ◽

Maurits S. Boon ◽

Gregory Epps ◽

Swar Vimawala ◽

...

Keyword(s):

Continuous Positive Airway Pressure ◽

Nasal Cavity ◽

Skull Base ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Skull Base Surgery ◽

Healthy Individuals ◽

Significant Difference ◽

The Impact ◽

Cadaveric Model

Background For patients with obstructive sleep apnea (OSA), there is a lack of knowledge regarding the impact of continuous positive airway pressure (CPAP) on the nasal cavity. There is a significant need for evidence-based recommendations regarding the appropriate use of CPAP following endoscopic sinus and skull base surgery. Objective The goal of this study is to translate a previously developed cadaveric model for evaluating CPAP pressures in the sinonasal cavity by showing safety in vivo and quantifying the effect of positive pressurized air flow on the nasal cavity of healthy individuals where physiologic effects are at play. Methods A previously validated cadaveric model using intracranial sensor catheters has proved to be a reliable technique for measuring sinonasal pressures. These sensors were placed in the nasal cavity of 18 healthy individuals. Pressure within the nose was recorded at increasing levels of CPAP. Results Overall, nasal cavity pressure was on average 85% of delivered CPAP. The amount of pressure delivered to the nasal cavity increased as the CPAP increased. The percentage of CPAP delivered was 77% for 5 cmH2O and increased to 89% at 20 cmH2O. There was a significant difference in mean intranasal pressures between all the levels of CPAP except 5 cmH2O and 8 cmH2O ( P < .001). Conclusion On average, only 85% of the pressure delivered by CPAP is transmitted to the nasal cavity. Higher CPAP pressures delivered a greater percentage of pressurized air to the nasal cavity floor. Our results are comparable to the cadaver model, which demonstrated similar pressure delivery even in the absence of anatomic factors such as lung compliance, nasal secretions, and edema. This study demonstrates the safety of using sensors in the human nasal cavity. This technology can also be utilized to evaluate the resiliency of various repair techniques for endoscopic skull base surgery with CPAP administration.

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Management of Malignant Tumors of the Anterior Skull Base and Paranasal Sinuses

Current Otorhinolaryngology Reports ◽

10.1007/s40136-016-0131-3 ◽

2016 ◽

Vol 4 (4) ◽

pp. 259-265

Author(s):

Sara Abu-Ghanem ◽

Moshe Yehuda ◽

Garrett D. Locketz ◽

Avraham Abergel ◽

Dan M. Fliss

Keyword(s):

Skull Base ◽

Paranasal Sinuses ◽

Malignant Tumors ◽

Anterior Skull Base

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Endonasal micro-endoscopic treatment of malignant tumors of the paranasal sinuses and anterior skull base

Operative Techniques in Otolaryngology-Head and Neck Surgery ◽

10.1016/j.otot.2006.06.002 ◽

2006 ◽

Vol 17 (3) ◽

pp. 152-167 ◽

Cited By ~ 29

Author(s):

Paolo Castelnuovo ◽

Paolo Battaglia ◽

Davide Locatelli ◽

Giovanni Delù ◽

Federica Sberze ◽

...

Keyword(s):

Skull Base ◽

Paranasal Sinuses ◽

Endoscopic Treatment ◽

Malignant Tumors ◽

Anterior Skull Base

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Imaging review of the anterior skull base

Acta Radiologica Open ◽

10.1177/2058460118776487 ◽

2018 ◽

Vol 7 (5) ◽

pp. 205846011877648 ◽

Cited By ~ 4

Author(s):

Olivia Francies ◽

Levan Makalanda ◽

Dimitris Paraskevopolous ◽

Ashok Adams

Keyword(s):

Soft Tissue ◽

Nasal Cavity ◽

Skull Base ◽

Paranasal Sinuses ◽

Anterior Skull Base ◽

Normal Anatomy ◽

Radiological Findings ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

The anterior skull base (ASB) is intimately associated with the unique soft tissue subtypes of the nasal cavity, paranasal sinuses, orbits, and intracranial compartment. Pathology involving the ASB is rare but the causes are manifold and can be broadly subdivided into those intrinsic to the skull base and processes extending from below or above. Sinonasal pathology is the most commonly encountered and poses significant management challenges that rely heavily on accurate interpretation of the radiological findings. We illustrate the normal anatomy of the ASB and present a cross-sectional imaging review of the pathological entities that may be encountered, focusing on the specific features that will impact on clinical and surgical management.

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Malignant tumors of ENT organs in Gomel region: DESCRIPTION of the patient cohort OVER 1998-2012

Health and Ecology Issues ◽

10.51523/2708-6011.2016-13-3-18 ◽

2016 ◽

pp. 85-91

Author(s):

S. A. Ivanov ◽

I. D. Shlyaga ◽

G. L. Grabareva

Keyword(s):

Nasal Cavity ◽

Paranasal Sinuses ◽

Malignant Tumors ◽

Tumor Stage ◽

Hypopharyngeal Cancer ◽

Annual Number ◽

Old Patients ◽

Number Of Patients ◽

At Iii ◽

Region Description

Objective: to analyze the distribution of the cohort of patients with malignant tumors of ENT organs in Gomel region over 1998-2012. Material and methods. We analyzed the absolute case numbers of cancer of the larynx, oropharynx, hypopharynx, nasal cavity and paranasal sinuses. The patients were grouped in accordance with sex, age, and tumor stage. Results. The most common sites of ENT tumor were: the larynx - 40 %, the hypopharynx - 27 %, the oropharynx - 24 % (2010-2012). The dynamics of the sites: stable number of patients with laryngeal and hypopharyngeal cancer and cancer of the nasal cavity and paranasal sinuses, increase in the number of patients with oropharyngeal and laryngopharyngeal cancer. The ratio of 50-64 year-old patients increased. More than half of the cases of cancer of the oropharynx, laryngopharynx, nasopharynx, nasal cavity and paranasal sinuses are detected at III-IV tumor stage. Conclusion. The annual number of patients with tumors of ENT organs in Gomel region is more than 200 and is increasing due to the cases of oropharyngeal and laryngopharyngeal cancer. More than 90 % of the patients are men of the employable age. Early diagnosis of tumors of ENT organs stays a topical issue in the region.

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Surgical Management of Tumors of the Nasal Cavity, Paranasal Sinuses, Orbit and Anterior Skull Base

Comprehensive Management of Skull Base Tumors ◽

10.3109/9781420014037-19 ◽

2008 ◽

pp. 227-265

Author(s):

Michael Kupferman

Keyword(s):

Nasal Cavity ◽

Skull Base ◽

Surgical Management ◽

Paranasal Sinuses ◽

Anterior Skull Base

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Recovery peculiarities and complications in the nasal cavity caused by skull base reconstruction with nasoseptal flap after transnasal removal of chiasmo-sellar mass lesions

Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery) ◽

10.33920/med-01-2101-03 ◽

2021 ◽

pp. 36-44

Author(s):

Svetlana Dmitrievna Nikonova ◽

Maksim Aleksandrovich Kutin ◽

Elizaveta Vladimirovna Shelesko ◽

Pavel Lvovich Kalinin ◽

Nadezhda Alekseevna Chernikova ◽

...

Keyword(s):

Nasal Cavity ◽

Skull Base ◽

Skull Base Surgery ◽

Low Frequency ◽

Cerebrospinal Fluid Leak ◽

Nasoseptal Flap ◽

Endoscopic Endonasal ◽

Skull Base Reconstruction ◽

Pubmed Database ◽

Skull Base Defect

Today, endoscopic endonasal approach is considered the gold standard in skull base surgery of the chiasmosellar region. Advances in transnasal endoscopic skull base surgery allow conducting more extensive interventions via wider approaches which requires more complicated plastic closure of the skull base defect. In 2006, G. Haddad et al. suggested using a vascularized nasoseptal flap to reconstruct a skull base defect. This method is generally accepted at present due to its reliability and low frequency of postoperative complications. The purpose of this article is to analyze publications on possible complications and pathological conditions of the nasal cavity when using a vascularized nasoseptal flap for skull base surgery after removal of neoplasms of the chiasmo-sellar region. The study included articles found in the Pubmed database (2006–2020) which described frequency and character of complications caused by skull base defect reconstruction by a nasoseptal flap after transnasal removal of chiasmo-sellar neoplasms. According to the literature review, the following complications are reported: cerebrospinal fluid leak, flap necrosis and infectious complications, pathological changes in the nasal cavity: prolonged crusting, synechiae, epistaxis, septum perforation, sinusitis, subatrophic changes of mucosae, nasolacrimal duct obstruction, olfactory dysfunction. The authors conclude that the nasoseptal flap is, undoubtedly, an effective material for reconstruction of dural defects by endoscopic endonasal skull base surgery, because of its good viability due to the preserved blood supply and high tightness of the plasty. However, there is a risk of complications in the nasal cavity. For these reasons, development of effective methods for prevention of nasal complications after using a vascularized flap in endoscopic endonasal surgery is an important issue today.

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